Int J Cardiol . Antithrombotic therapy in patients with COVID-19? -Rationale and Evidence

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Int J Cardiol


. 2020 Sep 28;S0167-5273(20)33894-8.
doi: 10.1016/j.ijcard.2020.09.064. Online ahead of print.
Antithrombotic therapy in patients with COVID-19? -Rationale and Evidence


Cosmo Godino ¹ , Andrea Scotti ² , Norma Maugeri ³ , Nicasio Mancini ⁴ , Evgeny Fominskiy ⁵ , Alberto Margonato ⁶ , Giovanni Landoni ⁷



Affiliations

• PMID: 33002521
• DOI: 10.1016/j.ijcard.2020.09.064

Abstract

In patients with severe or critical Coronavirus disease 2019 (COVID-19) manifestations, a thromboinflammatory syndrome, with diffuse microvascular thrombosis, is increasingly evident as the final step of pro-inflammatory cytokines storm. Actually, no proven effective therapies for novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection exist. Preliminary observations on anticoagulant therapy appear to be associated with better outcomes in moderate and severe COVID-19 patients with signs of coagulopathy and in those requiring mechanical ventilation. The pathophysiology underlying the prothrombotic state elicited by SARS-CoV-2 outlines possible protective mechanisms of antithrombotic therapy (in primis anticoagulants) for this viral illness. The indications for antiplatelet/anticoagulant use (prevention, prophylaxis, therapy) are guided by the clinical context and the COVID-19 severity. We provide a practical approach on antithrombotic therapy management for COVID-19 patients from a multidisciplinary point of view.

Keywords: Anticoagulants; Antiplatelet; Antithrombotic therapy; COVID-19; Coronavirus; Thromboinflammatory syndrome.